Scoliosis in adults

Patients aged over 18 years (adults) come to us, perhaps, more often than children. Surgeries on adults (37% of all the operations) are performed less frequently due to the presence of their comorbidities. In cases of severe scoliosis, such patients often suffer from heart diseases, pulmonary insufficiency, and displacement of intervertebral discs, which preclude options for the surgery on adults or turn such an operation into one having no chance for success. Most often in this situation, adult patients are victims of an improper treatment during their childhood, when orthopaedists ignore the surgical treatment and attach excessive importance to conservative techniques of treating patients with a progressive course of scoliosis. As an example, here are a few observations from practice.

1. Female patient, 37 years

The patient had been followed up since her childhood in a major regional centre, but had not been operated on for scoliosis. Her hump was removed at the age of 18.

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The dynamics of the development of scoliosis can be traced on the X-rays Click the picture to enlarge

2 years and 11 months old

3 years and 5 months old

5 years old

6 years old

7 years old

8 years old

9 years old, 32 degrees

20 years old, 98 degrees

22 years old, 112 degrees

24 years old, 113 degrees

37 years old, 120 degrees

THE SURGERY SHOULD HAVE BEEN PERFORMED ON THE PATIENT AT THE AGE OF EIGHT – NINE YEARS. However, at the time, the growing structure was not yet developed, so the operation could not be performed in time.

The patient was operated on using our technique, i.e., without damaging the spine, using the plastic possibilities that have been preserved in the body of an adult person.

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Nowadays, when the technical possibility has appeared to perform surgeries on children aged just six or seven years and avoid any heavy distortions, such a delay in performing the surgery is not justified, whatever arguments advocates of late operations may bring forward against it. If the system of the early surgical treatment of spinal curvatures is universally adopted, the problem of scoliosis in Russia will disappear; there will be no people with a curved back and a broken life.

A 78 degrees curvature of the spine. The patient complained of severe pain in the lower back. A surgery for correction of the chest and spine was performed without damaging the spine. Doctors relied on the patient’s mobility and the capacity of muscles and ligaments between the vertebrae to stretch. Typically, after the surgery, the pelvis moves slightly in the opposite direction. This is a hopeful sign. In subsequent 3-6 months pelvis comes to the correct position.

An X-ray shows that the surgery proved effective to significantly improve the anatomy of the patient’s spine and ribs. After two years, the residual curvature noticeably decreased due to the elasticity of the plates in combination with plasticity of the tissue and the reduction of the load on the individual vertebrae, which was achieved by using a large number of attachment points. The pain in the spine disappeared, the patient lives a normal life, and the metal structure gives no signs of its existence.

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4. Female patient, 29 years old. Diagnosis: dysplastic scoliosis

At the age of 13, a Harrington structure was implanted in her body, which soon broke down and shifted. After two years, a similar structure was implanted again. Thereafter, at intervals of four years, the structure length was extended twice, and, to ensure its stability, it was fixed using the patient’s own bones. For this purpose, parts of the vertebrae – 14 spinous processes, 32 articular processes between the vertebrae, four ribs, and six intervertebral discs were taken (removed). The vertebrae knitted together, but such a bone block did not, and could not, prevent a further curvature. This is due to the fact that the operating surgeon has a wrong idea of the spine as a rubber tube, which could be easily straightened. He did not know that structural changes in the vertebrae, having formed, prevent straightening the spine.
Gradually, the correction continued to fade away, so, upon admission, the angle of the curvature reached 60 degrees. The Harrington structure was removed, a strong 4-plate structure with a great number of mounting blocks was implanted to hold the spine at the obtained correction rate.

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Before the surgery: direct side view

Before the surgery: side view

The surgery. The bone blocks over the structure

The implanted structure

The pain stopped, the curvature decreased

It is, in fact, possible to correct a spine curvature in adult patients without damaging the spine. In this case, the structure is implanted for the lifetime as a support for their own weak spine.

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